While searching for a health insurance plan, you may have come across the terms—network hospitals and non-network hospitals. These terms are used to distinguish between hospitals that have collaboration with the insurance provider and those that don’t.

Health insurance companies often tie up with hospitals to give their customers a cashless claim facility. A high number of network hospitals provides you with more options when selecting a suitable healthcare partner. Keep reading to better understand what is the difference between network and non-network hospitals.

Network vs. Non-network Hospitals

Hospitals that partner with health insurance providers to facilitate treatment to policyholders without charging them any fees upfront are called network hospitals, which offer a cashless claim service. Some hospitals may charge higher fees to insured patients, affecting the bottom line for insurance providers.

Some hospitals may charge a higher fee to patients with an insurance policy, which impacts the bottom line of health insurance providers. By negotiating with certain hospitals and agreeing to a lower price for treatments, health insurance providers are able to reduce their indemnity costs. Additionally, the cashless claim service ensures that the claims are settled quickly and increases customer satisfaction. The partnership benefits both a hospital and health insurance providers, with network hospitals receiving more patients.

Conversely, hospitals, clinics, and other treatment centres that don’t participate in such an agreement with an insurance provider can be referred to as non-network hospitals.

How to Choose Between Network and Non-network Hospitals?

At times, you may find it confusing whether to go to a network hospital or a non-network hospital for your treatment. Here are some things to consider to make an informed decision:

1. Availability

The first thing to consider is the availability of care at the hospital of your choice. This is an important point to consider if you need to get emergency treatment. However, for planned treatments, you have the chance to screen network hospitals for the availability of necessary equipment, qualified doctors, and hospital beds/rooms. If the network hospitals near you lack these, you can consider non-network hospitals that have adequate facilities.

2. Quality of Care

The quality of care can vary from hospital to hospital. Thus, after confirming the availability of treatment at preferred hospitals, you can filter different options based on the quality of services provided at the hospitals. While going to a network hospital offers convenience, compromising on treatment quality for the sake of hassle reduction is not advisable.

3. Distance

The next thing to consider is the distance between your residence and the hospital, especially for procedures that require frequent follow-up visits. Shorter distances make commuting more convenient. For outpatient procedures with infrequent visits, a distant network hospital may be an option. However, for chronic conditions like hypertension, choose a nearby hospital, even if non-network, for a more accessible treatment plan.

When to Seek Treatment in a Non-Network Hospital?

Some of the common circumstances under which people may go to a non-network hospital are listed below:

1. In an emergency, you should go to the nearest hospital, regardless of whether they have a collaboration with the insurance provider or not.
2. If you have not availed of the cashless facility from your insurance provider, you can consider choosing a non-network hospital for your treatment.
3. If the network hospital is too far away from your home or in a different city, you should consider going to a non-network hospital.
4. If network hospitals nearby lack adequate resources, seeking treatment at a non-network hospital becomes necessary.
5. If insurance doesn't cover pre-existing conditions, individuals with such conditions may prefer a nearby non-network hospital over a distant network one.
6. During the waiting period of an insurance policy, individuals can choose any hospital for treatment, as claims cannot be raised during this period.

Investing in Health Through Health Insurance

While choosing a health insurance policy, it is recommended that you look for an insurance provider with a wide network of hospitals, especially in your city. This enables you to avail cashless claims without worrying about the paperwork. The rising healthcare costs emphasises the importance of health insurance so that you can secure your future and enjoy peace of mind. Additionally, it makes financial sense to get a health insurance plan that offers you a wide network of hospitals to choose from and does not require you to pay for your medical expenses in advance.

FAQs

Can I claim for medical expenses incurred at a non-network hospital?
Yes. Although you can raise a claim request and send the duly filled-out form with attachments of all the original documents required to support your claim at a non-network hospital, the process is inherently tedious. Thus, people don’t prefer to go to a non-network hospital.

Can a network hospital deny me treatment?
If the hospital has no occupancy to admit you or they don’t have the necessary resources or doctors to perform a procedure, they may request that you consider a different hospital.

What is the procedure for claiming medical expenses at a network hospital?
You need to inform the insurance provider about any planned procedures well in advance as per the policy guidelines and fill out a cashless claim settlement form at the network hospital to avoid paying for the hospital bills. In case of emergency treatments, you or your family members are required to share your insurance policy details with the hospital and inform the insurance provider about it within 24 hours of being admitted to the hospital.

How much time does it take to settle cashless claims?
Depending on various factors, it can take anywhere from a week or two for a cashless claim to be settled. After you have filled out the form at the network hospital and shared your policy details with them, you don’t have to do much. The insurance provider and the network hospital sort out the billings later, and the whole procedure takes less time than usual.

What is the difference between a network hospital and a non-network hospital?
One of the major differences between the two is that network hospitals don’t require patients to pay hospital bills upfront. Besides, the patients don’t have to collect, compile, and share numerous documents with the insurance provider, which reduces the hassle dramatically.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.